Provider Demographics
NPI:1588616395
Name:SHAFFER, KATHERINE A (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:A
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DEPT OF RADIOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-3740
Mailing Address - Fax:414-259-9290
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DEPT OF RADIOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-3740
Practice Address - Fax:414-259-9290
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI189202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
002000135KOtherHUMANA
WI1588616395Medicaid
002000135KOtherHUMANA
E68550Medicare UPIN